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Helping People Without Making Them Helpless: Fun, Functional, and Other F Words Tim Feeney, Ph.D....

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Helping People Without Making Them Helpless: Fun, Functional, and Other F Words Tim Feeney, Ph.D. Project Director New York Neurobehavioral Resource Project Binghamton, NY Clinical Director School and Community Support Services 600 Franklin Street Suite 110 Schenectady, New York USA 12305 [email protected] 518-372-2026 Slide 2 Im a person, not a patient; and Im not yours! Slide 3 Grandma Masses Rules for Success: The smart guys are the guys who learn from the other guys. Dont get all caught up in one thing; everyone believes their thing is the best thing and theyre usually wrong. So, shut-up and listen and learn and change. In order to be successful youve got to be eclectic; moreover, we need to learn from other literatures from other populations Slide 4 More Grandma Masse Models collect dust on shelves. Dont fall in love with a particular approach ideally, youll/well create a framework for intervention (a working theory) that will evolve with experience and evidence Slide 5 You can make people do things that they just dont want to do but the price for doing so will be high Slide 6 Poodle Slide 7 FUNCTIONAL does not equal Increased/Improved performance on standardized tests Slide 8 FUNCTIONAL does not equal Bowling or the The Friday Outing or the The really neat, really expensive, simulated... Slide 9 FUNCTIONALequals Creating stable routines of life that enable me to do what I need to do when I need to do it. Slide 10 A coach gets guys to do the things A coach gets guys to do the things they dont want to do so they can become the players that they want to be. - Walt Harris Were all coaches A good coach: A good coach: Alters his/her coaching to Alters his/her coaching to reflect the needs of the player reflect the needs of the player and conditions of the context. and conditions of the context. Never tries to play the game Never tries to play the game him or herself. him or herself. Slide 11 The glass aint half empty, its half full! and You can teach 1/2 empty people to become 1/2 full people (its hard to teach 1/2 empties to become 1/2 fulls) Slide 12 PERSON Motor SKills Cognition LanguageEmotionVolitionBehavior Human beings are a collection of relatively independent structures, processes, and systems Slide 13 Johns Cognition AttentionPerceptionMemoryOrganizationReasoningEF Arousal Select Direct/ Filter Maintain Divide Shift Encode/Store/Retrieve Episodic/Semantic Explicit/Implicit Declarative/Procedural Involuntary/Strategic Working Memory/ Knowledge Base Remote/Recent Pro/retrospective Iconic Sequence Categorize Associate Analyze Synthesize Inductive Deductive Analogical Divergent Convergent Goals for John - John will: 1.Increase duration of maintained attention 2.Increase prospective memory from 3 to 5 minutes 3.Increase category naming from 3 to 5 members per category Slide 14 Johns Language PhonologyMorphologySyntaxSemanticsPragmatics Receptive vs. Expressive Phrase Structure Rules Etc. Receptive vs. Expressive Lexicon Semantic Relations Discourse Structures Receptive vs. Expressive Speech-act Competence Conversational Competence Socio-linguistic Competence Goals for John: John will 1.Decrease mean naming latencies from 3 to 2 seconds 2.Include 5 basic story grammar elements in retellings 3.Use politeness markers in greeting people: 90% Slide 15 Johns Behavior John b1 b3 b12 b4 b1 b7 b62 b17 b17 b17 b4 b6 b9 b17 b12 b3 b8 b8 b5 b6 b17 Goals for John: John will 1.Increase frequency of b3 and b12 2.Decrease frequency of b17 John is the totality of his behaviors and the systematic relationships among them Slide 16 Alternative Understanding of Human Beings Sarah Pursuing personally meaningful goals While participating in culturally valued activities Using cultural tools, such as language, category schemes, mathematics, organizational supports, domain-specific strategies Mediated as necessary by individuals with greater expertise in that domain In social, cultural, and historical contexts In the presence of varied context facilitators and barriers Slide 17 Intervention Goals Sarah will successfully complete ___ meaningful task, with ___ supports, possibly using ___ tools/strategies, in ___ context (setting, people, activities), in order to achieve ___ goal. Possibly focusing intervention attention on some specific aspects of cognition, communication, social skills, behavioral self-regulation, or educational/vocational skills aspects that are either particularly weak or particularly important for Sarah. Slide 18 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Fluctuating Attention Characteristic: Fluctuating Attention Appropriate Pacing Strategy: Appropriate Pacing Delivering material in small increments and requiring responses at a rate consistent with the individuals processing speed increases the acquisition of new materials. Slide 19 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Memory Impairment Characteristic: Memory Impairment Errorless learning and high rates of success in interactions Strategy: Errorless learning and high rates of success in interactions Acquisition and retention of new information tends to increase with high rates of success (and error frequency increases with frequent errors and error correction). Slide 20 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Organizational Impairment and Inefficient Learning Characteristic: Organizational Impairment and Inefficient Learning Task analysis of activities and advance organizational support Strategy: Task analysis of activities and advance organizational support Careful organization of learning and tasks including systematic sequencing of intervention targets and advanced organizational supports increases success. Slide 21 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Inefficient Learning and Inconsistency in Performance Characteristic: Inefficient Learning and Inconsistency in Performance Massed practice and review including frequent cumulative review Strategy: Massed practice and review including frequent cumulative review Acquisition and retention of new information and consolidation of old information in memory is increased with frequent, routine-based review. Slide 22 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Inefficient Feedback Loops and Implicit Learning of Errors Characteristic: Inefficient Feedback Loops and Implicit Learning of Errors Errorless learning combined with corrective (and brief) feedback when errors occur. Strategy: Errorless learning combined with corrective (and brief) feedback when errors occur. Many individuals with severe memory and learning problems benefit from errorless learning. When errors occur, learning is enhanced when those errors are followed by non-judgmental corrective feedback. Slide 23 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Frequent Failure of Transfer/Concrete Thinking and Learning Characteristic: Frequent Failure of Transfer/Concrete Thinking and Learning Facilitation of transfer, generalization, and maintenance via contextual teaching. Strategy: Facilitation of transfer, generalization, and maintenance via contextual teaching. Generalization is more likely when skills are taught in the context in which they will be used (context is encoded with information). In addition, using a general case approach (wide range of examples and settings) increases generalization. Slide 24 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Unpredictable Recovery, Unusual Profiles, and Inconsistency in Behavior Characteristic: Unpredictable Recovery, Unusual Profiles, and Inconsistency in Behavior Ongoing assessment and flexibility in curricular modification. Strategy: Ongoing assessment and flexibility in curricular modification. Adjustment of interaction based on ongoing assessment of the individuals progress facilitates learning and allows for curricular modifications on the fly. Slide 25 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Impaired Strategic Behavior/ Impaired Organizational Functioning Characteristic: Impaired Strategic Behavior/ Impaired Organizational Functioning Strategy-based intervention. Strategy: Strategy-based intervention. Organized intervention designed to facilitate a strategic approach to difficult tasks, including organizational strategies. Slide 26 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Decreased Self-Awareness/ Denial of Deficits Characteristic: Decreased Self-Awareness/ Denial of Deficits Self-awareness/attribution training Strategy: Self-awareness/attribution training Facilitation of individuals understanding of his/her role in learning Slide 27 Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Behavioral Difficulties Characteristic: Behavioral Difficulties Positive behavior supports Strategy: Positive behavior supports Using an approach to behavior intervention that focuses primarily on the antecedents of behavior in the broadest sense (including setting events and establishing operations), environmental management, and role improvement. Slide 28 Fun as an Important Element of Rehabilitation Therapeutic: Serving to sure or heal Fun: Lively, joyous, playful Do you ever ask yourself: Where is the fun? rather than Are we having fun yet? Slide 29 FUN IS NOT: Worrying about being politically correct Worrying about being politically correct Going to therapy Going to therapy Doing a workbook activity Doing a workbook activity Work

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